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. 1991 May;46(5):325–333. doi: 10.1136/thx.46.5.325

Endoscopic palliation of tracheobronchial malignancies.

M R Hetzel 1, S G Smith 1
PMCID: PMC463129  PMID: 1712516

Abstract

The prognosis for tracheobronchial tumours remains poor. Most patients can be offered only palliation. When the main symptom is breathlessness or refractory haemoptysis from a large airway tumour endoscopic treatment may be very effective. Over the last decade most attention has focused on the neodymium YAG laser. This often produces dramatic effects but has some important limitations. In the last few years better techniques for stenting and intrabronchial radiotherapy (brachytherapy) have also been developed. This article discusses the range of techniques now available and aims to help clinicians decide which patients may benefit from referral to centres providing these techniques.

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Selected References

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  1. Allen M. D., Baldwin J. C., Fish V. J., Goffinet D. R., Cannon W. B., Mark J. B. Combined laser therapy and endobronchial radiotherapy for unresectable lung carcinoma with bronchial obstruction. Am J Surg. 1985 Jul;150(1):71–77. doi: 10.1016/0002-9610(85)90012-1. [DOI] [PubMed] [Google Scholar]
  2. Arabian A., Spagnolo S. V. Laser therapy in patients with primary lung cancer. Chest. 1984 Oct;86(4):519–523. doi: 10.1378/chest.86.4.519. [DOI] [PubMed] [Google Scholar]
  3. Boedker A., Hald A., Kristensen D. A method for selective endobronchial and endotracheal irradiation. J Thorac Cardiovasc Surg. 1982 Jul;84(1):59–61. [PubMed] [Google Scholar]
  4. Brutinel W. M., Cortese D. A., McDougall J. C., Gillio R. G., Bergstralh E. J. A two-year experience with the neodymium-YAG laser in endobronchial obstruction. Chest. 1987 Feb;91(2):159–165. doi: 10.1378/chest.91.2.159. [DOI] [PubMed] [Google Scholar]
  5. Burt P. A., O'Driscoll B. R., Notley H. M., Barber P. V., Stout R. Intraluminal irradiation for the palliation of lung cancer with the high dose rate micro-Selectron. Thorax. 1990 Oct;45(10):765–768. doi: 10.1136/thx.45.10.765. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Carpenter R. J., 3rd, Neel H. B., 3rd, Sanderson D. R. Cryosurgery of bronchopulmonary structures. An approach to lesions inaccessible to the rigid bronchoscope. Chest. 1977 Sep;72(3):279–284. doi: 10.1378/chest.72.3.279. [DOI] [PubMed] [Google Scholar]
  7. Cavaliere S., Foccoli P., Farina P. L. Nd:YAG laser bronchoscopy. A five-year experience with 1,396 applications in 1,000 patients. Chest. 1988 Jul;94(1):15–21. doi: 10.1378/chest.94.1.15. [DOI] [PubMed] [Google Scholar]
  8. Chetty K. G., Moran E. M., Sassoon C. S., Viravathana T., Light R. W. Effect of radiation therapy on bronchial obstruction due to bronchogenic carcinoma. Chest. 1989 Mar;95(3):582–584. doi: 10.1378/chest.95.3.582. [DOI] [PubMed] [Google Scholar]
  9. Clarke D. B. Palliative intubation of the trachea and main bronchi. J Thorac Cardiovasc Surg. 1980 Nov;80(5):736–741. [PubMed] [Google Scholar]
  10. Cooper J. D., Pearson F. G., Patterson G. A., Todd T. R., Ginsberg R. J., Goldberg M., Waters P. Use of silicone stents in the management of airway problems. Ann Thorac Surg. 1989 Mar;47(3):371–378. doi: 10.1016/0003-4975(89)90375-5. [DOI] [PubMed] [Google Scholar]
  11. Cortese D. A., Kinsey J. H. Endoscopic management of lung cancer with hematoporphyrin derivative phototherapy. Mayo Clin Proc. 1982 Sep;57(9):543–547. [PubMed] [Google Scholar]
  12. Dumon J. F., Reboud E., Garbe L., Aucomte F., Meric B. Treatment of tracheobronchial lesions by laser photoresection. Chest. 1982 Mar;81(3):278–284. doi: 10.1378/chest.81.3.278. [DOI] [PubMed] [Google Scholar]
  13. Dumon J. F., Shapshay S., Bourcereau J., Cavaliere S., Meric B., Garbi N., Beamis J. Principles for safety in application of neodymium-YAG laser in bronchology. Chest. 1984 Aug;86(2):163–168. doi: 10.1378/chest.86.2.163. [DOI] [PubMed] [Google Scholar]
  14. Frank F., Beck O. J., Hessel S., Keiditsch E. Comparative investigations of the effects of the neodymium:YAG laser at 1.06 microns and 1.32 microns on tissue. Lasers Surg Med. 1987;6(6):546–551. doi: 10.1002/lsm.1900060614. [DOI] [PubMed] [Google Scholar]
  15. Gelb A. F., Epstein J. D. Neodymium-yttrium-aluminum-garnet laser in lung cancer. Ann Thorac Surg. 1987 Feb;43(2):164–167. doi: 10.1016/s0003-4975(10)60388-8. [DOI] [PubMed] [Google Scholar]
  16. George P. J., Clarke G., Tolfree S., Garrett C. P., Hetzel M. R. Changes in regional ventilation and perfusion of the lung after endoscopic laser treatment. Thorax. 1990 Apr;45(4):248–253. doi: 10.1136/thx.45.4.248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. George P. J., Garrett C. P., Hetzel M. R. Role of the neodymium YAG laser in the management of tracheal tumours. Thorax. 1987 Jun;42(6):440–444. doi: 10.1136/thx.42.6.440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. George P. J., Garrett C. P., Nixon C., Hetzel M. R., Nanson E. M., Millard F. J. Laser treatment for tracheobronchial tumours: local or general anaesthesia? Thorax. 1987 Sep;42(9):656–660. doi: 10.1136/thx.42.9.656. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. George P. J., Irving J. D., Mantell B. S., Rudd R. M. Covered expandable metal stent for recurrent tracheal obstruction. Lancet. 1990 Mar 10;335(8689):582–584. doi: 10.1016/0140-6736(90)90358-c. [DOI] [PubMed] [Google Scholar]
  20. Gerasin V. A., Shafirovsky B. B. Endobronchial electrosurgery. Chest. 1988 Feb;93(2):270–274. doi: 10.1378/chest.93.2.270. [DOI] [PubMed] [Google Scholar]
  21. Gilmartin J. J., Veale D., Cooper B. G., Keavey P. M., Gibson G. J., Morritt G. N. Effects of laser treatment on respiratory function in malignant narrowing of the central airways. Thorax. 1987 Aug;42(8):578–582. doi: 10.1136/thx.42.8.578. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Hayata Y., Kato H., Konaka C., Amemiya R., Ono J., Ogawa I., Kinoshita K., Sakai H., Takahashi H. Photoradiation therapy with hematoporphyrin derivative in early and stage 1 lung cancer. Chest. 1984 Aug;86(2):169–177. doi: 10.1378/chest.86.2.169. [DOI] [PubMed] [Google Scholar]
  23. Hayata Y., Kato H., Konaka C., Ono J., Takizawa N. Hematoporphyrin derivative and laser photoradiation in the treatment of lung cancer. Chest. 1982 Mar;81(3):269–277. doi: 10.1378/chest.81.3.269. [DOI] [PubMed] [Google Scholar]
  24. Hetzel M. R., Millard F. J., Ayesh R., Bridges C. E., Nanson E. M., Swain C. P., Williams I. P. Laser treatment for carcinoma of the bronchus. Br Med J (Clin Res Ed) 1983 Jan 1;286(6358):12–16. doi: 10.1136/bmj.286.6358.12. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Hetzel M. R., Nixon C., Edmondstone W. M., Mitchell D. M., Millard F. J., Nanson E. M., Woodcock A. A., Bridges C. E., Humberstone A. M. Laser therapy in 100 tracheobronchial tumours. Thorax. 1985 May;40(5):341–345. doi: 10.1136/thx.40.5.341. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Hooper R. G., Jackson F. N. Endobronchial electrocautery. Chest. 1985 Jun;87(6):712–714. doi: 10.1378/chest.87.6.712. [DOI] [PubMed] [Google Scholar]
  27. Häussinger K., Held E., Huber R. Endobronchial laser therapy--differential therapeutic use and clinical value. Klin Wochenschr. 1984 Jan 16;62(2):74–80. doi: 10.1007/BF01769666. [DOI] [PubMed] [Google Scholar]
  28. Jain P. R., Dedhia H. V., Lapp N. L., Thompson A. B., Frich J. C., Jr Nd:YAG laser followed by radiation for treatment of malignant airway lesions. Lasers Surg Med. 1985;5(1):47–53. doi: 10.1002/lsm.1900050107. [DOI] [PubMed] [Google Scholar]
  29. Kvale P. A., Eichenhorn M. S., Radke J. R., Miks V. YAG laser photoresection of lesions obstructing the central airways. Chest. 1985 Mar;87(3):283–288. doi: 10.1378/chest.87.3.283. [DOI] [PubMed] [Google Scholar]
  30. Law M. R., Henk J. M., Goldstraw P., Hodson M. E. Bronchoscopic implantation of radioactive gold grains into endobronchial carcinomas. Br J Dis Chest. 1985 Apr;79(2):147–151. [PubMed] [Google Scholar]
  31. Ledingham S. J., Goldstraw P. Diathermy resection and radioactive gold grains for palliation of obstruction due to recurrence of bronchial carcinoma after external irradiation. Thorax. 1989 Jan;44(1):48–51. doi: 10.1136/thx.44.1.48. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. MONTGOMERY W. W. T-TUBE TRACHEAL STENT. Arch Otolaryngol. 1965 Sep;82:320–321. doi: 10.1001/archotol.1965.00760010322023. [DOI] [PubMed] [Google Scholar]
  33. Macha H. N., Koch K., Stadler M., Schumacher W., Krumhaar D. New technique for treating occlusive and stenosing tumours of the trachea and main bronchi: endobronchial irradiation by high dose iridium-192 combined with laser canalisation. Thorax. 1987 Jul;42(7):511–515. doi: 10.1136/thx.42.7.511. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Maiwand M. O. Cryotherapy for advanced carcinoma of the trachea and bronchi. Br Med J (Clin Res Ed) 1986 Jul 19;293(6540):181–182. doi: 10.1136/bmj.293.6540.181. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Majid O. A., Lee S., Khushalani S., Seydel H. G. The response of atelectasis from lung cancer to radiation therapy. Int J Radiat Oncol Biol Phys. 1986 Feb;12(2):231–232. doi: 10.1016/0360-3016(86)90098-2. [DOI] [PubMed] [Google Scholar]
  36. McDougall J. C., Cortese D. A. Neodymium-YAG laser therapy of malignant airway obstruction. A preliminary report. Mayo Clin Proc. 1983 Jan;58(1):35–39. [PubMed] [Google Scholar]
  37. Mehta A. C., Livingston D. R. Biopsy excision through a fiberoptic bronchoscope in the palliative management of airway obstruction. Chest. 1987 May;91(5):774–775. doi: 10.1378/chest.91.5.774. [DOI] [PubMed] [Google Scholar]
  38. Mehta M., Shahabi S., Jarjour N., Steinmetz M., Kubsad S. Effect of endobronchial radiation therapy on malignant bronchial obstruction. Chest. 1990 Mar;97(3):662–665. doi: 10.1378/chest.97.3.662. [DOI] [PubMed] [Google Scholar]
  39. Moghissi K., Jessop T., Dench M. A new bronchoscopy set for laser therapy. Thorax. 1986 Jun;41(6):485–486. doi: 10.1136/thx.41.6.485. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Nori D., Hilaris B. S., Martini N. Intraluminal irradiation in bronchogenic carcinoma. Surg Clin North Am. 1987 Oct;67(5):1093–1102. doi: 10.1016/s0039-6109(16)44347-1. [DOI] [PubMed] [Google Scholar]
  41. Personne C., Colchen A., Leroy M., Vourc'h G., Toty L. Indications and technique for endoscopic laser resections in bronchology. A critical analysis based upon 2,284 resections. J Thorac Cardiovasc Surg. 1986 May;91(5):710–715. [PubMed] [Google Scholar]
  42. SINCLAIR W. K. Artificial radioactive sources for interstitial therapy. Br J Radiol. 1952 Aug;25(296):417–419. doi: 10.1259/0007-1285-25-296-417. [DOI] [PubMed] [Google Scholar]
  43. Sanderson D. R., Neel H. B., Payne W. S., Woolner L. B. Cryotherapy for bronchogenic carcinoma: report of a case. Mayo Clin Proc. 1975 Aug;50(8):435–437. [PubMed] [Google Scholar]
  44. Shankar S., George P. J., Hetzel M. R., Goldstraw P. Elective resection of tumours of the trachea and main carina after endoscopic laser therapy. Thorax. 1990 Jun;45(6):493–495. doi: 10.1136/thx.45.6.493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Shapshay S. M., Beamis J. F., Jr Use of CO2 laser. Chest. 1989 Feb;95(2):449–456. doi: 10.1378/chest.95.2.449. [DOI] [PubMed] [Google Scholar]
  46. Simonds A. K., Irving J. D., Clarke S. W., Dick R. Use of expandable metal stents in the treatment of bronchial obstruction. Thorax. 1989 Aug;44(8):680–681. doi: 10.1136/thx.44.8.680. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Slawson R. G., Scott R. M. Radiation therapy in bronchogenic carcinoma. Radiology. 1979 Jul;132(1):175–176. doi: 10.1148/132.1.175. [DOI] [PubMed] [Google Scholar]
  48. Spinelli P., Pizzetti P., Lo Gullo C., Rocca F., Gobbi A., Ravasi G. Resection of obstructive bronchial fibrolipoma through the flexible fiberoptic bronchoscope. Endoscopy. 1982 Mar;14(2):61–63. doi: 10.1055/s-2007-1021579. [DOI] [PubMed] [Google Scholar]
  49. Strong M. S., Jako G. J. Laser surgery in the larynx. Early clinical experience with continuous CO 2 laser. Ann Otol Rhinol Laryngol. 1972 Dec;81(6):791–798. doi: 10.1177/000348947208100606. [DOI] [PubMed] [Google Scholar]
  50. Strong M. S., Jako G. J., Polanyi T., Wallace R. A. Laser surgery in the aerodigestive tract. Am J Surg. 1973 Oct;126(4):529–533. doi: 10.1016/s0002-9610(73)80044-3. [DOI] [PubMed] [Google Scholar]
  51. Toty L., Personne C., Colchen A., Vourc'h G. Bronchoscopic management of tracheal lesions using the neodynium yttrium aluminium garnet laser. Thorax. 1981 Mar;36(3):175–178. doi: 10.1136/thx.36.3.175. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Vincent R. G., Dougherty T. J., Rao U., Boyle D. G., Potter W. R. Photoradiation therapy in advanced carcinoma of the trachea and bronchus. Chest. 1984 Jan;85(1):29–33. doi: 10.1378/chest.85.1.29. [DOI] [PubMed] [Google Scholar]
  53. Wallace M. J., Charnsangavej C., Ogawa K., Carrasco C. H., Wright K. C., McKenna R., McMurtrey M., Gianturco C. Tracheobronchial tree: expandable metallic stents used in experimental and clinical applications. Work in progress. Radiology. 1986 Feb;158(2):309–312. doi: 10.1148/radiology.158.2.3941857. [DOI] [PubMed] [Google Scholar]
  54. Walsh D. A., Maiwand M. O., Nath A. R., Lockwood P., Lloyd M. H., Saab M. Bronchoscopic cryotherapy for advanced bronchial carcinoma. Thorax. 1990 Jul;45(7):509–513. doi: 10.1136/thx.45.7.509. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Warner M. E., Warner M. A., Leonard P. F. Anesthesia for neodymium-YAG (Nd-YAG) laser resection of major airway obstructing tumors. Anesthesiology. 1984 Mar;60(3):230–232. doi: 10.1097/00000542-198403000-00011. [DOI] [PubMed] [Google Scholar]
  56. Weishaupt K. R., Gomer C. J., Dougherty T. J. Identification of singlet oxygen as the cytotoxic agent in photoinactivation of a murine tumor. Cancer Res. 1976 Jul;36(7 Pt 1):2326–2329. [PubMed] [Google Scholar]
  57. Westaby S., Jackson J. W., Pearson F. G. A bifurcated silicone rubber stent for relief of tracheobronchial obstruction. J Thorac Cardiovasc Surg. 1982 Mar;83(3):414–417. [PubMed] [Google Scholar]

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